MEDICARE: OPTUM PHARMACY 702, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336M0002X	Mail Order Pharmacy

General Provider Information

NPI Number	:	1326846585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM PHARMACY 702, LLC

Provider Business Mailing Address
First Line	:	1 OPTUM CIR
Second Line	:	STE 100
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344
Country	:	US
Telephone Number	:	800-328-5979
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 PATROL RD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-7750
Country	:	US
Telephone Number	:	855-427-4682
Fax Number	:	877-223-1603

Authorized Official
Title or Position	:	SECRETARY
Name	:	KEVIN EUGENE BURR
Credential	:
Telephone Number	:	712-310-4701

Provider Enumeration Date	:	03/04/2025
Last Update Date	:	03/04/2025

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